Reading · Womankind: Always Hormonal

Last month I lay on a gynaecologist’s examination bed and asked, clearly and politely, for pain relief before my endometrial biopsy. I had done my research and the updated NHS Women’s Health Strategy specifically addresses the need for adequate pain management during gynaecological procedures, and I felt confident enough to ask. As a woman with endometriosis and adenomyosis I live with chronic pelvic pain, so avoiding additional pain is a high priority for me and the doctor knew this.

I was brushed off.

The procedure lasted only a few minutes. The pain was excruciating. I went home and spent three days in significant pelvic pain, and somewhere in the back of my mind, in a place I am still unpicking, I realised I had already half expected this to happen. Not because I thought the pain would be minor, but because I have spent a lifetime as a woman in a medical system that has consistently treated my pain as something to be managed, minimised or endured rather than prevented and taken seriously.

I am not unusual. I am not unlucky. I am one of millions.

What happened to me in that consultation room is not an isolated incident, and the research makes that uncomfortably clear. Studies consistently show that women’s pain is underestimated, undertreated and dismissed at every level of the healthcare system. A 2024 study published in the Proceedings of the National Academy of Sciences found that when clinicians were presented with identical male and female patient charts reporting the same level of pain, they consistently judged the female patient’s pain as less severe. The gender of the clinician made no difference. Male and female doctors and nurses were equally likely to underestimate a woman’s pain.

Women also wait longer for that undertreated pain to be acknowledged. Research shows that women spend an average of 30 minutes longer than men in emergency departments before receiving any care, and are 10% less likely to have their pain scores recorded by nursing staff at all. When women do receive treatment for pain, they are more likely to be prescribed sedatives or antidepressants than actual analgesics. Men reporting the same pain are more likely to be given medication that actually addresses it.

In gynaecological care, where women’s pain should be taken most seriously of all, the gap is particularly stark. Only 30% of physicians offer anaesthesia for IUD insertion, despite 70% of women reporting moderate to severe pain during the procedure. My experience with an endometrial biopsy, a procedure that can be significantly more painful than an IUD insertion, is part of a pattern so well documented it has its own name. Researchers call it the gender pain gap. Women have been living inside it for their entire lives.

To understand how we got here, it helps to know where the word “hysterical” comes from. It derives from the ancient Greek word hystera, meaning womb. For centuries, women who expressed distress, pain or strong emotion were diagnosed as hysterical, a condition considered peculiar to the female sex and rooted in the uterus itself. The medical establishment has moved on from that specific diagnosis, but the underlying assumption, that women’s reports of pain are emotionally coloured, exaggerated or unreliable, has proved far more difficult to shift.

There is also the question of what women are expected to endure simply by virtue of being female. Menstrual pain is described to girls from their first period as normal, something to manage with a hot water bottle and ibuprofen and get on with. Childbirth is held up as the apex of human pain tolerance, something women are built for and therefore capable of withstanding. The cumulative cultural message, absorbed over a lifetime, is that pain is part of the female experience in a way it simply is not for men. And when pain is considered normal, it stops being considered a problem worth solving.

Women absorb this message too. Research shows that women are socialised to minimise their own pain, to describe significant pain as “a bit uncomfortable”, to apologise for mentioning it at all, to present as the “good patient” who does not make a fuss. That self-silencing is the product of a lifetime of social conditioning, and it has real and measurable consequences for the quality of care women receive.

The consequences of the gender pain gap are not abstract. They are measurable, serious and in some cases fatal.

Endometriosis affects an estimated 1.5 million women in the UK, and the average time to diagnosis is now nine years and four months, according to the most recent data from Endometriosis UK. Nine years of pain that is routinely dismissed as bad periods, managed with the contraceptive pill and sent away. Nine years in which the disease can progress, cause permanent organ damage and significantly affect fertility, mental health and quality of life. The diagnostic delay is not purely a failure of medical knowledge. It is also a failure of medical belief. Women’s pain is not being taken seriously enough to investigate it properly.

The consequences extend well beyond gynaecological health. Women are significantly more likely than men to die from a heart attack, and a key reason is that their symptoms are less likely to be recognised and treated with urgency in emergency settings. Women’s cardiac symptoms often present differently to the classic male presentation, and when a woman describes her symptoms she is more likely to be told it is anxiety, stress or something she can manage at home. The pain gap, in cardiology as in gynaecology, costs lives.

This is not a problem of individual attitudes. It is a cultural pattern so deeply embedded that it operates largely below the level of conscious awareness, in the assumptions clinicians bring to a consultation, in the language women use to describe their own bodies, in the collective belief that female pain is normal and therefore not urgent.

That belief has to be actively challenged, not just by medical institutions but by women themselves. Describing pain accurately and without apology is not being difficult. Asking for pain relief before a procedure is not an unreasonable request. Refusing to accept “it’s just part of being a woman” as a clinical response is not overreacting. These are acts of self-advocacy that women should not have to perform, but until the system catches up, they remain necessary.

What needs to change is not small and it is not simple, but it is clear. Medical education must include mandatory training on the gender pain gap, not as an optional module but as a core component of clinical training. Pain assessment tools need to be applied consistently regardless of the patient’s sex. Gynaecological procedures that are known to cause significant pain must be accompanied by adequate pain relief as standard, not as a concession granted to women who are assertive enough to ask for it.

The NHS Women’s Health Strategy has begun to acknowledge this. It specifically commits to improving pain management in gynaecological settings. But a strategy is only as powerful as its implementation, and implementation requires the medical profession to confront an uncomfortable truth: that the system has been systematically undertreating women’s pain for a very long time, and that changing it requires more than goodwill. It requires accountability.

Women should not have to arrive at appointments armed with research, rehearsed arguments and a strategy for being believed. They should be able to describe their pain and trust that it will be taken seriously. That is not a radical expectation. It is the most basic standard of care, and women have been waiting long enough for it.

Built to Endure: Why the Gender Pain Gap Is Costing Lives

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